Hormone Therapy(Estrogen Therapy, Estrogen/Progestin Therapy)

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Hormone therapy facts

Estrogen therapy is the most highly effective prescription medication for treating menopause symptoms and in light of recent research is still safe and effective for many women when used for fewer than five years.

The use of estrogen therapy without progesterone (progestin), is associated with an increase in the risk of uterine cancer (endometrial cancer, cancer of the lining of the uterus).

Treatment with progesterone along with estrogen substantially reduces the risk of uterine cancer (endometrial cancer) so that the risk of developing this cancer is equivalent to that of women not taking estrogen.

Users of oral hormone therapy (HT) (in the doses of the Women's Health Initiative) for more than five years are at slightly increased risk of breast cancer risk, heart disease, and stroke than are nonusers.

The term "hormone therapy" or "HT" is being used to replace the outdated terminology "hormone replacement therapy" or "HRT."

What is menopause?

Menopause is the stage in a woman's life when menstruation stops and
she can no longer bear children. During menopause, the body produces less of the
female
hormones, estrogen and progesterone. After
menopause, the lower hormone levels cause the monthly menstrual periods to stop
and gradually eliminate the possibility of
becoming pregnant. These fluctuations in hormone levels can also
cause troublesome symptoms, such as hot flashes (a sudden
sensation of warmth, sometimes associated with flushing, and often followed by
sweating) and sleep
disturbance. Sometimes women experience other symptoms, such as vaginal dryness
and mood changes.

While many women
encounter little or no trouble during menopause, others endure moderate to
severe discomfort.

Does menopause cause bone loss?

The lower estrogen levels of menopause can lead to
progressive bone loss that is especially rapid in the first five years after
menopause. Some bone loss in both men and women is normal as people age. Lack of
estrogen after menopause adds another strain on the bones in addition to the
usual age-related bone loss. When bone loss is severe, a condition called
osteoporosis weakens
bones and renders them susceptible to breaking.

Menopause Symptoms

Some of the symptoms of menopause can actually begin years before
menstrual periods stop
occurring. Doctors generally use the term "perimenopause" to refer
to the time period beginning prior to the menopause (when some of the signs and
symptoms of menopause begin to occur) up through the first year following
menopause. Menopause itself is defined as having had 12 consecutive months
without a menstrual period.

Menopause symptoms begin gradually while the ovaries are still functioning
and a woman is still having menstrual periods. These symptoms can begin as early
as the 4th decade of life (when a woman is in her 30s) and may persist for years
until menopause has occurred. The symptoms occur early because the levels of
hormones produced by the ovaries (estrogen and progesterone) decline
slowly over time, explaining why pregnancy is still possible, but less likely to occur, as a
woman reaches her forties. The severity and duration of symptoms vary widely
among individuals - some women may experience only minimal symptoms for a year
or two, while others may experience at least some of the symptoms for several
years.

While most women will experience a gradual transition to
menopause with a slow onset of symptoms, some women will experience an early (premature)
menopause that may bring on immediate symptoms, depending on the cause of the
ovarian failure. One common cause of immediate symptoms is a "surgical
menopause" following the surgical removal of functioning ovaries.

Menopause symptoms can be perceived as physical problems, emotional
disturbances, or problems associated with sexual functioning.